I've done residency and fellowship(s) at two kinds of places. In residencies with many fellowships and very high volume (large academic medical centers), fellows on subspecialty sign out services tend to gobble up the surgical cases. This may not lead to optimal resident training. In programs with few (or no) fellowships and medium volume, the residents can handle and read out most of the cases in general sign out. Grossing and autopsies are also lighter. Just my opinion. More volume/fellowships isn't always better for resident training.